What causes total hair loss on the scalp?

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Q. What causes total hair loss on the scalp (alopecia totalis)? Are there cures?

A. Alopecia totalis is a severe form of the medical condition alopecia areata, in which a person loses hair in patches on parts of the body or head. Alopecia totalis is hair loss on the entire scalp, and alopecia universalis is complete hair loss all over the body. Lynne Goldberg, professor of dermatology at Boston University School of Medicine, says the condition can appear in childhood or adulthood and has an unpredictable course; hair may fall out and then regrow, the condition may improve spontaneously, or continue for years.

Current thinking is that alopecia areata is “an autoimmune disease where the body’s immune system is fighting something in the hair,” she says, but the reasons for this immune attack are unknown. The disease tends to run in families, but not everyone who develops it has a family history.

There is no cure for the disease, but treatments are available that can stimulate hair growth in some people, including steroid injections, topical steroids, and other topical medications. Some physicians use a substance to stimulate a mild allergic reaction at the site of hair loss, which sometimes restores hair growth. But Goldberg cautions that treatments are limited, particularly for more severe hair loss.

Hair loss can take an emotional toll; the National Alopecia Areata Foundation offers support and resources for people with the disease, and the organization Locks of Love provides hairpieces to disadvantaged children with alopecia areata.